Effect of Diabetes Mellitus and Left Ventricular Perfusion on Frequency of Development of Heart Failure and/or All-cause Mortality Late After Acute Myocardial Infarction.
Type 2 diabetes mellitus (DM) has a detrimental impact on cardiovascular outcomes, with implications for prognosis following ST elevation myocardial infarction (STEMI).The aim was to evaluate the impact of DM and myocardial perfusion on the long-term risk of heart failure (HF) and/or all-cause mortality following primary percutaneous coronary intervention (pPCI) for STEMI. A total of 406 STEMI patients (104 with DM) treated with pPCI were enrolled in this observational study. Myocardial perfusion was reassessed with the Quantitative Myocardial Blush Evaluator (QuBE). Follow-up data on HF (ICD10 (International Statistical Classification of Diseases) codes I50.0 – I50.9) and all-cause mortality were obtained from the National Health Fund. During a 6-year follow-up, 36 (35%) patients with DM died compared to 45 (15%) patients without DM (P<0.001). Also, 24 (23%) patients with DM developed HF compared to 51 (17%) patients without DM (P=0.20). Patients with DM and HF had the highest mortality rate (75%), and those with DM and a QuBE score below the median value (9.0 arb. units) had significantly higher risk of HF (hazard ratio HR=1.96, 95% CI 1.18-3.27, P=0.0099) and the composite of HF and/or all-cause mortality (HR=1.89, 95% CI 1.33-2.69, P=0.0004). In conclusion DM (type 2) and diminished myocardial perfusion increase the risk of HF and/or all-cause mortality during a 6-year follow-up following pPCI for STEMI.